The push to immunize all children against polio has been hampered by the ongoing crisis in the Syrian Arab Republic. WHO and UNICEF have appealed to all parties to cooperate, including through temporary pauses in hostilities where needed, to allow vaccination campaigns to take place and for all children to be protected.

When Dr Salah Salem Haithami, a medical officer with WHO, heard that polio had reappeared in the Syrian Arab Republic, his first thought was: can I go there to help? He had been working for a dozen years on polio eradication in Sudan, but just days later he was deployed to Damascus.

Haithami’s second thought was for children in Yemen, his own country. “Polio does not have a passport – it can affect any child anywhere in the world,” he says. “My motivation is to help stop the polio outbreak in Syria and, in this way, to prevent children outside of Syria from being paralyzed for life.”

Since he arrived in Damascus in October, Haithami has focussed day and night on the polio vaccination campaign. “I have helped order vaccines and other supplies. I have shared our experience from the Sudan and other countries and got agreement for new tactics like house-to-house visits and finger-marking, so that vaccinators really reach every single child. I have met with people in all sectors of Syrian society to try and gain crucial support for the campaigns,” he explains.

“All children have the right to be protected from the crippling poliovirus, and the provision of healthcare must remain neutral, regardless of the context."

The first suspected polio cases in Syria were flagged on 17 October 2013. On 29 October the Government of Syria announced that wild poliovirus had been isolated from 10 paralyzed children in Deir Ez Zour, one of the most fiercely contested areas of the country. Even before this laboratory confirmation, health authorities across the region had begun the planning and implementation of a comprehensive outbreak response. That campaign started on 24 October.

As of late November, 17 children had been paralyzed by polio in three separate Governorates of the Syrian Arab Republic, which had previously not recorded polio for over a decade.

The push to immunize all children against polio has been hampered by the ongoing internal conflict in the Syrian Arab Republic. “We are appealing to all parties to cooperate with temporary pauses in hostilities over the coming 6 months to allow vaccination campaigns to take place and for all children to be reached,” says Dr Ala Alwan, Regional Director, WHO Eastern Mediterranean Regional Office. “All children have the right to be protected from the crippling poliovirus, and the provision of healthcare must remain neutral, regardless of the context.”

Campaigns targeting 22 million children under 5 years

Recognizing the high risk of spread to countries in the region and beyond, in October/November 7 countries and territories held mass polio vaccination campaigns targeting 22 million children under the age of 5 years. In a joint resolution in early November, all countries of the WHO Eastern Mediterranean Region declared the escalating polio situation to be an emergency for the entire Region, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination, in both the Middle East and in Pakistan, from where the outbreak virus had originated. It is estimated that campaigns will need to continue for the next 6 to 8 months to ensure all children in Syria and surrounding countries are vaccinated.

WHO is working with UNICEF, other UN agencies, the Syrian Arab Red Crescent and its committed local volunteers, international and national NGOs, and other local and international groups providing humanitarian assistance to Syrians affected by the conflict to ensure that all children are vaccinated, no matter where they live. It is anticipated that outbreak response activities will need to continue for 6 to 8 months, depending on the area and based on the evolving epidemiology.

“This outbreak underscores the importance of ending polio everywhere, particularly in the 3 remaining endemic countries: Afghanistan, Nigeria and Pakistan,” Dr Alwan says. “As long as polio persists in these reservoirs, the world will always be at risk of outbreaks. We must do everything possible to reach all children in those areas.”